Week 8 Study Guide Flashcards
Essential Terms
-AIDS-defining conditions= serious diseases that occur in HIV+
-Antiretroviral therapy (ART)= interferes with HIV being able to reproduce itself
-Immune reconstruction Inflammatory reconstruction (IRIS)= inflammatory disorders that are worsening of infectious processes following ART
-Opportunistic infection= infections that occur more often in people with weakened immune systems
-Seroconversion= when HIV antibodies are produced and test from negative to positive, within a few weeks
-Serodiscordant= one partner HIV+ other is HIV-
-Viral load= the amount of virus in an infected persons blood
-Viral set point= viral replication is still taking place but immune system is unable to destroy the virus in equal amounts as its being produced
Human Immunodeficiency Virus (HIV)
- Hijacks the body’s own immune system for viral replication, eventually kills patients R/T opportunistic infections arising from weakened immune system
- Been around sine early 80’s
- Risk factors in order of incidence: unprotected sexual contact, IV drug usage, mother/child in pregnancy, occupational exposure (not common), blood transfusion
- If you get a needle stick: wash the area under running water with out squeezing it, permission from patient for lab tests to determine their viral status, post-exposure prophylaxis
How HIV Enters the Body
1- Viral transmission = virus gets in to body
2- Acute viral infection= HIV cells are engulfed by our bodies CD4 cells and then HIV cells take over
3- Seroconversion= it is there to stay
4- Asymptomatic chronic infection
5- Symptomatic chronic infection
6- AIDS
7- Death via opportune infections
HIV Co-morbidities
-TB
-Malaria
-Malnutrition
-Co-morbidities makes the process move faster
-Untreated patients have a 12 year life span
Prevention better than Treatment
- Education
- Safe sex
- PrEP
- Screening
- High risked individuals should be screened yearly
- Men having sex with men (MSM)
- People coming to STI clinic
- incarcerated
- Routine screening SHOULD be offered for everyone
Labs to Monitor for Patients with HIV
- CD4 lymphocytes and viral load
- Goal with treatment: More CD4 and less viral load. Signs of worsening will have less CD4 and more viral load
Stages of HIV Disease
(2 questions)
- HIV stage 1= > 500 CD4 cells
- HIV stage 2= 200-499 CD4 cells
- HIV stage 3 (AIDS)= < 200 CD4 cells
Management of HIV+ Patient
- Monitor vial load and CD4 every 3-6 months until fully established on medication regimen
*If CD4 <200, then drawn monthly and prophylactic ABX started, can be stopped when CD4 is >200 for 3 months in a row - Monitor TB test every 6 months
- Medication: Antiretroviral Therapy (ART)
* Minimum of 3 different drugs from 2 different classes. ** Hepatic and renal function must be monitored prior to starting and periodically during therapy *** Adherence rate needs to be >/=95% to achieve viral load of zero ** Therapy is lifelong
Management of HIV+ Patient (cont.)
- Immunizations (need to stay up to date, NO live vac.): *Live= MMR, Chicken Pox (Varicella), rotavirus, small pox, polio ORAL **Inactivated/dead= Flu, polio SHOT, Covid, Hep A, HPV, DTaP
- Complications include opportunistic Infections (OI) = viral, bacterial, fungal, parasitic?
-AIDS-defining illnesses:
*Pneumocystitis Carinii Pneumonia (PCP)- SOB, dyspnea, cough, fever
*Mycobacterium Avium (tuberculosis)- night sweats, cough, fever
*Toxoplasmosis- fever, headache, fatigue
Complications of HIV
- Opportunistic Infections (OI)
- AIDS- defining illnesses
- Pneumocystitis Carinii pneumonia (PCP): SOB, dyspnea, cough, fever,
- Mycobacterium Avium: Night sweats, cough, fever
- Toxoplasmosis: Fever, headache, fatigue
-S&S of deterioration: FEVER, new onset cough, increased fatigue, night sweats, new onset headache, new skin lesions, weight loss
Bactrim and HIV
(2 questions)
- Do not administer Bactrim to HIV +
- Causes a short delayed allergic reaction that causes hemolytic anemia - blood transfusion reaction/ body starts destroying itself.
- S&S: weak, pale, fatigue, increase HR, less oxygen, hypotension, increase respiration, low H&H
In- hospital Precautions for an HIV+ Patient
(2 questions)
- Standard precautions / all patient care
- Infection control practices to prevent transmission of disease that is acquired by blood, body fluids, non-intact skin like rashes, and mucous membranes
- hand hygiene, PPE as needed, sharps safety,
STD ESSENTIAL TERMS
- Atypical= abnormal cells
- Colposcopy= examines cervix, vagina, and vulva
- Cytolysis= disruption of cells by an external agent
- Cytology= single cell exam to diagnose cancer, screen fetal abnormalities, pap smears
- Epididymitis= inflammation of the small coiled tube at the back of the testicle (swollen or red scrotum, testicle pain)
- Fitz-Hugh-Curtis Syndrome= chronic pelvic inflammatory disease (PID)
- Incubation period= time when infection occurred to the onset of signs and symptoms of the first positive test
- Lymphadenopathy= swelling of lymph nodes that is 2nd to bacterial, viral, or fungal infections
- Obligate intracellular bacterium= require a eukaryotic host to survive and replicate
-Pathogenesis= development of a disease - Prodromal= from the start of symptoms to the development off rash or fever
- Reiter’s Syndrome= common inflammatory polyarthritis in young men
- Salpingitis= inflammation of the fallopian tubes caused by bacterial infection
- Subclinical= disease that has not progressed enough to show observable symptoms
-Urethritis= inflammation of the urethra - Dysuria= painful urination
- Dyspareunia= painful intercourse
STDs Background Info
- Tell infected patients to tell their partners
- Be tested, have partners tested
- Utilize safe sex practices: condoms, monogamy, abstinence, vaccination, communicate with partner, do not use drugs and alcohol
- (birth control and STD prevention are different)
- Many STDs are commonly asymptomatic
- Many STDs spread more easily from man to women than vice versa
Human Papillomavirus (HPV)
- Most sexually active people who aren’t vaccinated against HPV will become infected at some point in their lives
- There are two varieties; oncogenic and non-oncogenic
Non-Oncogenic
- appearance of genital warts that are painless- little pain, uncomfortable, itchy
- Can be treated with creams or gels, or removed by a physician with cryotherapy.
- Can cause an issue in pregnancy but you also cannot use cream or gels while pregnant,
- May have to have a c-section due to warts occluding birth canal
Oncogenic = tumor formation
- No to little symptoms
- Can cause morphological changes to infected cells over time. AKA cancerous changes
- An average of 90% of people clear their infections over time
- Infections that do not clear up can increase chances of cancer in the affected area: cervical, vaginal, penile, oropharyngeal, anal
Treatment for the oncogenic strains
- Ablation: freezing or burning abnormal tissue
- Excision: cutting off abnormal tissue
- Loop Electrosurgical Excision (LEEP): electrically heated loop of wire to remove abnormal tissue
- Laser Conization: laser light to remove abnormal tissue
- Vaccinations exists for both men and women > can reduce cervical cancer rates by 90%
HPV and Cancer
- Cervical Cancer: only cancer caused by HPV that has a recommended screening test to detect it an early stage = 11,000 cases a yr
- Cervical Pre-cancers: screenings can detect pre-cancers before they turn into cancer, treatment for pre-cancers can lead to problems during pregnancy = 196,000 cases a yr
- Other Cancers Caused by HPV: no recommended screening tests, may not be detected until they cause serious health problems > 14,000/ back of throat, 6,500/ anus, 2,800/ Vulva, 900/ penis, 700/vagina
- HPV vaccination during age 11-12 could prevent over 90% of these cancers
Syphilis
-Epidemiology: after dropping rapidly in the in the 1940’s after Penicillin was developed, it’s on the rise around the world again related to HIV. 105,000 deaths worldwide in 2015
- Spread by sexual contact, caused by bacteria called Treponema Pallidum
Syphilis S&S, Diagnosis, and Treatment
S&S:
- skin lesion at point of infection called a chancre, can become an area of ulceration
- followed by lymphadenopathy and a skin rash on the palms, soles of feet, and trunk
- Untreated syphilis can then become systemic, effecting CNS, cardiovascular, etc
Diagnosis: testing of blood or fluid collected from chancres and ulceration areas
Treatment: A single dose of Penicillin
Herpes Simplex Virus (HSV)
- Chronic viral infection (1:5 Americans)
- 2 main variants:
*HSV1: mostly oral-oral route. Cold sores.
Can lead to genital herpes. More prevalent
in America
*HSV2: mostly genital-genital route, more
prevalent worldwide - No cure for HSV; outbreak/remission, after 1st infection, there will be at least one outbreak in more than 75% people, some who have an outbreak 6+ times a year
- Easily transmitted to women from men than vice versa
-Risk Factors: unprotected sex/many partners, MSM, history of STI’s, incarceration, <25, unmarried,
HSV S&S
- One or many clear, fluid filled vesicles (blisters) in the genital area
- Vesicles then rupture, forming open ulcerations that can last 2-4 weeks without treatment
- Painful, itching, burning associated with vesicles and ulcerations
- Symptoms more severe in women
- Symptoms preceded by a prodromal phase: an abnormal sensation prior to outbreak: tingling, itching, burning
- Can have systemic symptoms with vesicles eruption
*Fever, headache, dysuria, myalgia (muscle pain/soreness), swollen lymph nodes in groin, burning/tingling
HSV Treatment
- Antiviral medications such as Acyclovir
- Suppresses the infection, provides symptom relief
- Most useful when taken early in the outbreak * Teach patients to seek treatment when that prodromal stage is noted, PRIOR to vesicle eruption
- Patients with more than 6 outbreaks a year may be put on suppressive therapy, constant daily antiviral therapy to prevent outbreaks
- Symptom Management: warm salt baths to dry up lesions and ease pain/discomfort of vesicles, ice to affected area, loose-fitting clothing
Chlamydia
- Most common STD
- Bacterial: Chlamydia trachomatis
- Risk Factors: <25 years old, multiple sexual partners, history of STDs, unmarried, MSM
Chlamydia S&S and Treatment
- Women: dysuria, dyspareunia, lower abdomen pain, vaginal bleeding (postcoital or inter-menstrual), vaginal discharge, cervical issues
-Men: dysuria, urethral discharge, inflammation of urinary meatus
Treatment: ABX/ usually a single dose of Azithromycin
*2nd line: Doxycycline. **Expedited Partner Therapy (EPT) is used
- Complications: if untreated, travel up the uterus and fallopian tubes and lead to PID and infertility. In men, can travel up the ureter, causing epididymitis (inflammation of the tube connecting the testicle to the penis) which can cause infertility
Gonorrhea
- Bacteria: Neisseria Gonorrheae
- 2nd most common STD after Chlamydia
- Risk Factors: <25 years old, multiple sexual partners, history of STDs, unmarried, MSM
- Complication: if untreated, can lead to PID and infertility
Gonorrhea S&S and Treatment
-S&S: half of infected men/women experience symptoms
- “rrhea” = discharge or flow
- Women-> copious vaginal discharge (purulent/gross), intermenstrual bleeding, dysuria, discomfort
- Men-> dysuria, copious urethral discharge (purulent and gross)
- Treatment: cephalosporin & macrolide like azithromycin dual treatment due to antibiotic resistant gonorrhea
Pelvic Inflammatory Disease (PID)
- Epidemiology: 2.5 million women aged 18-44 have experienced PID in their lifetime (60,000 hospitalized/yr, 106,000 outpatients/yr)
- Caused by an infection like chlamydia, gonorhhea, normal vaginal flora grown out of control
- Infection starts in vagina and ascends to the upper genital trace (uterus, fallopian tubes, ovaries)
PID S&S and Treatment
-S&S: systemic infection symptoms, fever, unusual/ heavy discharge that may have an odor, unusual bleeding, pain during sex, painful/frequent/difficult urination, sepsis, septic shock
*lower abdominal tenderness/pain, uterine tenderness, pain/tenderness noted on gynecological exam (adnexal tenderness and cervical motion tenderness), diagnosis of chlamydia/ gonorrhea
- Treatment should be started when PID is suspected
*ABX: oral or IV depending on severity of symptoms, abx regimen to be decided by physician- take as directed and for the entire course to prevent abx resistance
- Avoid activities that can bring more bacteria into the upper genital tract: BATHS, TAMPONS, DOUCHING, SEXUAL INTERCOURSE
General STD Stuff
- Psychosocial issues in STDs real and prevalent
* not just from friends and family, the perception of judgement from healthcare providers keeps people from seeking treatment -> “I dont want to tell me parter” isnt selfish its fear - Patient education is important
- sex ed in sucks in schools and from parents
